Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214627 DEA: 05344904 EFIS: 0500000505
QA Service Level: 1
DIST-CO-RTE-PM: 05-SBT-156-3/R8.2
Work Description: SAN BENITO ROUTE 156 IMPROVEMENT PROJECT SAN BENITO RTE 156 IMPROVEMENT PROJECT; INCLUDES NEW BRIDGE AND WIDENING OF EXISTING BRIDGE.
Location Description: SAN BENITO COUNTY IN AND NEAR SAN JUAN BAUTISTA FROM THE ALAMEDA TO 0.2 MILE EAST OF FOURTH STREET/BUSINESS ROUTE 156
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 223 Harrison Road 1B, Salinas, CA 93907
Resident Engineer: Frank (Farrukh) Sana Structure Rep.: Bonaventure Ezeji
DIME Sample ID: 2023-06-02-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: SMTL TM5 - Welded Hoops
Sample Taken Date: 06/02/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 880
A brief description of the sample: Welded Hoops
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CMC Rebar
Production or Authorization Testing: Production Testing
Service or Ultimate: Ultimate
Rebar Heat Number(s): 4129486
Hoop Manufacturer Lot Number(s): 1 thru 6
Material Standard Code: ASTM A706
Material Grade: 60
Rebar Size: #6
Diameter of Hoop: 1'-6"
Epoxy Coated: No
Epoxy Coating Color: NA
Rebar Manufacturer: CMC
Welding Company: CMC Rebar San Bernardino
Coating Standards: Uncoated
Weld Type: Flash Welded
